Juvenal da Rocha Torres Neto

Estudo histomorfométrico de anastomoses primárias de cólon em coelhos, com e sem preparo intestinal

Colon laudering is used in many colon surgeries. The LIATO, that promotes cleanness of colon, demonstrates an increase of the surgical time and increase risk of infection. This study compares colonic anastomosis with and without preparation, through histomorfometric analysis. 30 rabbits were submitted to the surgery treatment and had been evaluated and divided in groups: group 1 (control) and group 2 (LIATO). Carried through statistical study with the program Prism® 4 for p< 5%. The analisis found acute inflammatory infiltrated with discrete bigger average in the anastomoses of group 2. Chronic inflammatory infiltrated with average of 1,9 in the anastomoses of group 2 and of 2,1 in the ones without preparation. Necrosis in 15,7% in the LIATO against 13,5% in the group without preparation. Calcium deposit in 43% of the anastomoses with preparation and in 30%, of the ones without preparation. Bigger colagen concentration were met in the anastomoses made with the intestinal laudering. Incidence of interlaced colagen fibres was observed in 86% of the anastomoses of the searched one and in 70% in the control group. We conclude that the LIATO presents better incidence of interlaced colagen fibres and fibre concentration resulting in better anastomosis.

Estudo demográfico do câncer de cólon e reto no estado de Sergipe

In Brazil, the colorretal cancer (CRC) was the fifth cause of death for cancer in men and fourth, in women in the period of 1995-1999. However, there are few registers on the epidemiologicals aspects of this pathology in Sergipe, being this the focus of this study. OBJECTIVE: To catalogue all CRC cases diagnosed in Sergipe in the period of 03 years (2003-2005), tracing a demographic study. METHOD: The data had been harvested in findings of all pathological anatomy laboratories on the state. RESULTS: The CRC was more frequent in women (n=201; 56,62%) than in men (n=154; 43,38%). The average age was 60,27 years old, and 39 (10,99%) had up to 40 years old. Adenocarcinoma was the histology type more found, present in 295 (83,10%) patients. In Sergipe, the incidence of CRC in 2003, 2004 and 2005 was 4,57; 4,72 and 5,29 per 100.000 men and, 6,07; 5,57 and 6,98 per 100.000 women respectively. In the capital, in this respectives years, these numbers had increased to 10,25; 10,57 and 10,29 per 100.000 men and 12,92; 13,16 and 15,07 per 100.000 women. CONCLUSIONS: The achieved data are similar to the ones of the literature, showing an increase in the annual incidences of the neoplasm.

Cirurgias proctológicas em 3 anos de serviço de coloproctologia: série histórica

In 2007, 72,5% of all surgeries of Coloproctology Departament were from anal procedures. Three years experience of the Medical post-graduation were resumed and analyzed in this study retrospectively. Total 455 patients were submitted to hemorrhoidectomy (40%), fistulectomies (20%) and fissurectomies (13%) and others like pilonidal disease, rectovaginal fistulas. In general, these pathologies are more prevalent in women (54%) from 30 to 50 years old. Hemorrhoids and fissure affected more women, while fistulas affected men. Milligan and Morgans hemorrhoidectomy was realized in 53,7% of the cases with pain and bleeding patterns comparable to Ferguson technique. It had provided a bigger number of residual fissure and fecal incontinence. Stenosis was the same in both methods. Ferguson technique had lowest repair time, even with high tax of dehiscence. Fistula affects four times more men than women. In 65% of the cases, fistulectomy was the technique choice, with better results in terms of pain and bleeding and worse tax of incontinence. Seton was inserted in 14% of the cases, and it was used in average for 20 weeks, and after its withdrawal, 36% referred minor incontinence. The anal fissure showed preference to posterior place. The anterior fissures occurred more in men.

Aspectos epidemiológicos dos pólipos e lesões plano-elevadas colorretais

INTRODUCTION: Colorectal polyps and flat injuries are important for the prevention of colorectal cancer due to the malignancy of adenomas. OBJECTIVE: To describe the demographic profile of patients with endoscopic diagnosis of colorectal polyps and/or flat injuries at University Hospital of Universidade Federal de Sergipe and Torres Medical Center. METHODS: A total of 6,919 records were evaluated from January 2002 to December 2007 with respect to the following variables: age, gender, origin, indication; injury evaluation os number, size, morphology, histology, dysplasia degree, topography; synchronics and metachronics injuries and associated diagnoses. RESULTS: 1,031(13.51%) colorectal polyps and flat injuries were found in 935 tests, accounting for 826 patients, 46% males and 54% females. The age ranged from 3 to 96 years with average of 53.64. The most frequent topographic distribution of polypoid injuries were rectum and sigmoid (58.40%). The injuries were sessile in 52.80% of the cases, pedicle in 27.90%, and flat injuries in 19.30%. There were synchronical injuries in 23.48% of patients and metachronic in 22 patients. Histologically, 43.36% were adenomas, being 85.70% tubular, 9.60% tubulovillous and 4.70% villous; hyperplastic polyps were found in 30.64% of the cases, inflammatory in 15.80% and 10.20% presented other histological types. The adenomas showed low-grade dysplasia in 83.40% and high degree in 16.60% of the patients. Seven were adenoma-carcinomas, one was carcinoid and one was gastrointestinal stromal tumor. CONCLUSIONS: The colonoscopy and polypectomy are important in diagnosis and prevention of colorectal cancer.

Avaliação da analgesia pós-operatória em pacientes submetidos à cirurgia orificial com anestesia local associada ou não à morfina

It has not been proved the efficacy of morphine derived at periphery opium receivers. Studies are trying to demonstrate the power of the drug to interfere in the intensity of surgical pain while infiltrating in the periphery nerves. This study evaluated the infiltration of morphine associated with local anesthesia in anorectal surgery. Sixty one patients were analyzed, male and female, divided in two groups: in one group was associated morphine in the local anesthesia while in the other group only the local anesthetic was used. The patients of both groups were submitted to the same protocol standardized sedative during the surgery and postoperative analgesia. The intensity of pain was evaluated when it appeared, the time with analgesia was analyzed and other complications were registered. The intensity of pain was similar in both groups, the time with analgesia was longer in the group where morphine was used, although it was not significant in the statistics and the complications after the surgery were not significant in both groups. So the infiltration of morphine in the anorectal region has benefices in the postoperative analgesia but it was not significant in the statistics and it does not increase the complications related with morphine as urinary retention and itching.

Uso da peritoneostomia na sepse abdominal

Among the therapeutics approach form of abdominal sepsis, the laparostomy has a decisive role allowing cavity explorations and lavages in an easier way. We study patients with abdominal sepsis diagnoses admitted to our surgical service of Coloproctology form Sergipe´s Federal University Hospital who underwent a Bogota Bag laparostomy associated or not with polypropylene mesh from January 2004 to January 2006. These patients were assessed as: first and second diagnosis; secondary peritonitis type; antibiotic-therapy; lavages setup; laparostomy´s time; complications and the end of the treatment. We study 10(83.3%) men and 2(16.7%) women, with average age of 39,3 (15-57). First diagnosis: inflammatory abdomen acute 6(50%), block acute abdomen 2(16.7%), perforative acute abdomen 2(16.7%), fistula 1(8.3%) and intracavity abscess 1(8.3%). Secondary diagnosis: colon perforation in 4(33.3%), intracavity abscess 3(25%), anastomoses dehiscence 3(25%), 1(8.3%) with sigmoid perforative cancer and 1(8.3%) with colon necrosis. Fecal peritonitis was found in 10 patients (83.3%) and purulent in 2(16.7%). The antibiotic-therapy was made during nineteen days. Lavages on demand 6(50%), planned with 4(33.3%) and mixed setup in 2(16.7%). The average time of the laparostomy was 10,9 days (1-36). Complications: evisceration in 2 cases (16.7%) and fistulization in only one (8.3%). Four patients died.

Tratamento da doença hemorroidária com ligadura elástica: estudo prospectivo com 59 pacientes

A ligadura elastica (LE) e considerada um metodo minimamente invasivo para o tratamento da doenca hemorroidaria (DH) e apresenta vantagens em relacao a hemorroidectomia, como: simplicidade de execucao e realizacao ambulatorial sem o emprego de anestesia. Trata-se de um metodo eficaz, principalmente nos portadores de DH grau II. Porem, apresenta complicacoes, sendo as mais frequentes: dor, tenesmo, hematoquezia e retencao urinaria. Alguns trabalhos mostram complicacoes mais graves, como sangramentos vultosos que necessitaram de hemotransfusao. Assim, este trabalho avaliou a eficacia e a morbidade do tratamento da DH pelo metodo da LE. Foi um estudo prospectivo, com 59 pacientes. Destes, cinco (8,5%) eram portadores de DH grau I, 33 (55,9%) de DH grau II e 21 (35,6%) de DH grau III. Todos os pacientes foram submetidos pelo menos a duas sessoes. Nas 135 sessoes realizadas, encontramos: hematoquezia em 62 (45,9%), dor intensa em 39 (28,9%), sintomas vagais em 10 (7,4%) e pseudoestrangulamento em um (0,7%) sessao. A taxa de cura do prolapso hemorroidario entre os portadores de DH grau II foi de 87,9% e entre aqueles com DH grau III, de 76,2%. O tratamento da DH pelo metodo da ligadura elastica mostrou-se seguro e com boa taxa de cura.

Avaliação do tratamento de fissura anal crônica com isossorbida tópica a 1 por cento

INTRODUCTION: Chronic anal fissures are deep, benign and painful ulcers. The involved factors are local trauma, sphinter hypertonia and poor blood flow. Surgery is gold standard treatment, but it causes fecal incontinence. Medical non-surgical therapy gets transitory resting pressure reduction and cure of lesions, without muscular damage. METHODS: In order to evaluate the treatment of chronic anal fissures using topical isossorbide (ISO) 1%, a randomizated and double-blind study twas carried out in Coloproctology Section of Universidade Federal de Sergipe (UFS), Sergipe, Brazil, during one year. Twenty-four patients were evaluated: 14 in Group 1 - ISO cream, and 10 in Group 2 - placebo. Resting pressure profile, improvement of painful symptoms and degree of scaring of the fissure were evaluated. RESULTS: Ulcer was more prevalent in women, constipation was present in 58.3%. The evacuatory pain was less common in Group 2, but without statistical significance. After 60 days, the healing was equal in the both groups (50%). There was a small reduction of resting pressure means at the end of 30 and 60 days, without statistical significance. Healing patients presented more resting pressure reducing. CONCLUSION: ISO cream did not influence the manometric response standard; otherwise it offered clinical improvement in both groups, whose scarring index was similar.

Cirurgias colorretais no Hospital Universitário da Universidade Federal de Sergipe: três anos da criação do Serviço de Coloproctologia (série histórica)

We studied colorectal surgeries carried through by the SC-HU/UFS from January 2004 to July 2006, historical series, referring to the creation of the colorectal medical residence. Registres by seventy patients that 53(75.7%) were masculine sort and 17(24.3%) feminine; medium age is 52 years. They had been submitted to the 102 procedures, 1,4 surgeries/patients, 29 reoperations. Nineteen(18.6%) had been reconstitutions of intestinal transit, 15(14.8%) retossigmoidectomy, 11(10.8%) total colectomy, 9(8.8%) right colectomy, 6(5.8%) abdomino-perineais amputations, 3(2.9%) proctocolectomy, 2(1.9%) left colectomy. Eighteen (17.6%) surgeries were indicated for colorectal cancer, 8(7.8%) of rectum and 1(0.9%) of the anal canal; 10(9.9%) for megacolon; 10(9.9%) previous colostomy, 5(5.9%) Crohns Disease, 5(4.9%) DDC, 3(2.9%) RCUI. Forty-eight (47.1%) surgeries have had surgical complication: 32(31.4%) ISOS, 13(12.7%) abdominal abscess, 11(10.8%) fistulas, 7(6.9%) dehiscences of anastomoses, etc. We observe wound infection in 27(26.5%) surgeries. Fifty-five(53.9%) patients had been submitted to the anastomoses, 32(58.2%) manual and 23(41.8%) stapled ones. It had dehiscence of anastomoses in 7(12.7%) surgeries: 1(3.1%) dehiscence for manual anastomoses and 6(26.1%) dehiscences for stapled anastomoses. Death in 11(15.7%) patient ones occurred. We evaluate the main data of the work objectifying to define goals, to elaborate and to improve the effective protocols, necessary to the good performance of the residence service.

Peutz-Jeguers syndrome: case report and literature review

The Peutz-Jeghers syndrome is a rare disease characterized by the presence of mucocutaneous melanic pigmentation of the lips, oral mucosa and perioral region, associated with hamartomatous intestinal polyposis. Malignization of the polyps and association with other types of cancer are also usual. Case report: 32-year-old patient, female, white, who had an intestinal occlusion by invagination, discovered during laparotomy, when an intestinal tumor was found as well. The material was sent to anotomopathological analysis. However, the results did not allow to identify the tumor nature due to tumor necrosis. Then, the patient was sent to our service because of the intestinal polyps, and during the interview, the characteristic melanic pigmentation was observed. Videocolonoscopy was performed, with excision of two rectal polyps, identified in the anatomopathological exam as hamartomatous polyps. The patient reported anal imperforation at birth, just like her brother. He had unexplained death. The authors found no correlation of the Peutz-Jeghers syndrome with anal imperforation in the literature and asked the patient if her brother also had the syndrome.